Hepatitis B virus (HBV) viremia despite tenofovir disoproxil fumarate-containing antiretroviral therapy in persons with HBV/ HIV coinfection
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Date
2024
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Journal of Clinical Virology
Abstract
Background: The goal of treatment of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) coin
fection is suppression of both viruses; yet incomplete HBV suppression on tenofovir (TFV) disoproxil fumarate
(TDF)-based antiretroviral therapy (ART) is common. This study investigated TFV resistance-associated muta
tions (RAMs) in individuals with HBV/HIV coinfection with viremia on TDF/lamivudine (3TC)-containing ART.
Methods: Samples from individuals with HBV DNA levels ≥20 IU/mL in a cross-sectional study of 138 persons
with HBV/HIV coinfection in Ghana were analyzed in the present study. HBV was sequenced for RAM analysis.
TFV-diphosphate (TFV-DP) concentration in peripheral blood mononuclear cells (PBMCs) was used to assess ART
adherence level.
Results: Nine of 138 participants (6.5 %) had detectable HBV DNA levels ≥20 IU/mL while on ART. Seven of the
nine participants had TFV-DP concentrations commensurate with 7 doses per week, and six had suppressed HIV
RNA. Phylogenetic analysis revealed that eight sequences were HBV genotype E, with one genotype E/A re
combinant. Ten previously-reported TFV RAMs were present in the study samples; eight were wild-type for HBV
genotype E. The non-genotype-E-wild-type point mutations M267L and K333Q were found in two and one pa
tients, respectively. No 3TC RAMs were found.
Conclusion: HBV viremia despite high adherence to TDF/3TC-based ART may be associated with the presence of
TFV RAMs. These findings highlight the need for enhanced resistance monitoring and further research to
examine the clinical significance of reported TFV RAMs. Individuals with HBV/HIV coinfection and TFV resis
tance on TDF-based ART may need alternative treatment strategies.
Description
Research Article
Keywords
Hepatitis B virus (HBV), HIV coinfection, Antiretroviral therapy